Health Advisories

Developed as a primary method to share information with federal, state, territorial, and local public health practitioners, clinicians, and public health laboratories, CDC’s Health Alert Network (HAN) is the primary method to share information on urgent public health incidents. The State of West Virginia has a similar system (WV-HAN) designed to share information on urgent public health incidents specific to West Virginia as well.

Below you will find information on the latest Health Alerts, both nationally and specific to West Virginia, as they occur.

Since acute flaccid myelitis (AFM) was first recognized in the United States in 2014, only two confirmed cases have been reported in West Virginia (both in 2016). Though no cases have been reported in 2017, healthcare providers are encouraged to continue vigilance for cases of AFM among all age groups and report suspected cases of AFM to their local health departments. Reporting of cases will help public health monitor the occurrence of AFM to better understand factors associated with this illness.

Influenza activity has increased significantly in the United States in recent weeks. West Virginia is characterized as having widespread activity. This influenza season is notable for the sheer volume of ill cases that has caused stress to health systems. The Centers for Disease Control and Prevention (CDC) released a Health Advisory (https://emergency.cdc.gov/han/han00409.asp) that warned of a high-severity influenza A (H3N2) season and resulting clinical implications. As of January 6, 2018, 20 pediatric influenza deaths were reported nationally, none in West Virginia.

West Virginia will report the highest number of Lyme disease cases on record in 2017. As of November 8, 2017, 571 confirmed and probable Lyme disease cases have been reported compared to the previous record of 368 cases in 2016. The geographic distribution of cases has also increased. As of November 8, 2017, 45 counties have reported at least one confirmed or probable Lyme disease case, up from 11 counties in 2012. This increase could be the result of increased reporting, increase in the number of Ixodes scapularis ticks infected with Borrelia burgdorferi in West Virginia, or a recent change in the national surveillance case definition for Lyme disease. Based on the change, West Virginia is considered a high incidence Lyme disease state, and the presence of an erythema migrans (EM) with known exposure in the state is sufficient for a patient to be classified as a confirmed surveillance case.

The Centers for Disease Control and Prevention (CDC) is working with federal, state, territorial, and local agencies and global health partners in response to recent hurricanes. CDC is aware of media reports and anecdotal accounts of various infectious diseases in hurricane-affected areas, including Puerto Rico and the US Virgin Islands (USVI). Because of compromised drinking water and decreased access to safe water, food, and shelter, the conditions for outbreaks of infectious diseases exist.

The Texas Department of State Health Services, with assistance from CDC, is investigating Brucella RB51 exposures and illnesses that may be connected to the purchase and consumption of raw (unpasteurized) milk from K-Bar Dairy in Paradise, Texas. Symptoms of brucellosis can include: fever, sweats, malaise, anorexia, headache, fatigue, muscle & joint pain, and potentially more serious complications (e.g., swelling of heart, liver, or spleen, neurologic symptoms).

Carbon monoxide (CO) is an odorless, colorless, poisonous gas that can cause sudden illness and death if present in sufficient concentration in the ambient air. During a significant power outage, persons using alternative fuel or power sources such as generators or gasoline powered engine tools such as pressure washers might be exposed to toxic CO levels if the fuel or power sources are placed inside or too close to the exterior of the building causing CO to build up in the structure. The purpose of this HAN advisory is to remind clinicians evaluating persons affected by the storm to maintain a high index of suspicion for CO poisoning. Clinicians are advised to consider CO exposure and take steps to discontinue exposure to CO. Clinicians are also advised to ask a patient with CO poisoning about other people who may be exposed to the same CO exposure, such as persons living with or visiting them so they may be treated for possible CO poisoning.

Based on data collected from May 24, 2017 to July 26, 2017, the West Virginia Department of Health and Human Resources, Bureau for Public Health Mosquito Surveillance Program is reporting several West Nile virus (WNV) positive mosquito pools across West Virginia with the greatest number of infected mosquitoes from Cabell County. WNV positive mosquito pools have also been detected in Berkeley, Fayette, Kanawha, Putnam, Wayne, Wetzel, and Wood counties this season.

The Centers for Disease Control and Prevention (CDC), State and Local Health Departments, and the Food and Drug Administration (FDA) are investigating an increase in reported cases of cyclosporiasis. The purpose of this HAN Advisory is to notify public health departments and healthcare facilities and to provide guidance to healthcare providers of the increase in reported cases. Please disseminate this information to healthcare providers in hospitals and emergency rooms, to primary care providers, and to microbiology laboratories.

The Bureau for Public Health is investigating an increase in newly diagnosed human immunodeficiency virus (HIV) cases in the State among persons at high risk for infection. In addition to syphilis (reported among several of the cases), this at-risk population remains at high risk for hepatitis B and C infection.

This Health Advisory serves as a reminder to all healthcare providers and laboratorians to report outbreaks, communicable diseases, and unusual conditions or emerging infectious diseases during the National Boy Scout Jamboree as required by the West Virginia Legislative Rule for Reportable Diseases, Events and Conditions (64CSR7). West Virginia will host the 2017 National Boy Scout Jamboree from July 19-28, 2017 at the Summit Bechtel Family National Scout Reserve in Mount Hope, West Virginia

Summary
Eculizumab (Soliris®) recipients have a 1,000 to 2,000-fold greater risk of invasive meningococcal disease compared to the general U.S. population. The Food and Drug Administration (FDA)-approved prescribing information for eculizumab includes a black box warning for increased risk of meningococcal disease, and the Advisory Committee on Immunization Practices (ACIP) recommends meningococcal vaccination for all patients receiving eculizumab. Recent data show that some patients receiving eculizumab who were vaccinated with the recommended meningococcal vaccines still developed meningococcal disease, most often from nongroupable Neisseria meningitidis, which rarely causes invasive disease in healthy individuals.

Children are particularly vulnerable to lead exposure due to the effect on their developing brains and organ systems. The U.S. Food and Drug Administration (FDA) and Centers for Disease Control and Prevention (CDC) are warning Americans that certain lead tests manufactured by Magellan Diagnostics may provide inaccurate results for some children and adults in the United States. FDA is now warning that M age llan Dia gn ostics’ Le adC are® ana l yzer s (LeadCare, LeadCare II, LeadCare Ultra and LeadCare Plus) should no longer be used with venous blood samples due to the potential for falsely low test results.

The U.S. Food and Drug Administration (FDA) has issued a safety communication warning about the use of Magellan Diagnostics’ LeadCare® analyzers (LeadCare, LeadCare II, LeadCare Ultra and LeadCare Plus) with venous blood samples because they might result in falsely low test results. FDA is now advising that Magellan Diagnostics’ LeadCare® analyzers should no longer be used with venous blood samples. The safety alert does not apply to capillary blood lead test results collected by fingerstick or heelstick. The purpose of this Health Advisory is to notify state and local health departments, healthcare providers, and laboratories about CDC’s re-testing guidance in light of the safety alert.

Mosquito-borne diseases occur annually in West Virginia beginning in early spring and peaking in August and September, coinciding with mosquito activity. Arboviral infections, particularly La Crosse encephalitis (LAC) and West Nile virus (WNV), are endemic mosquito-borne diseases identified in West Virginia. In 2016, eight LAC cases and one WNV case were reported in West Virginia. Persons with severe arboviral infections will often have symptoms of encephalitis. Please be vigilant in identifying such cases, and ensure that all hospitalized patients with encephalitis undergo appropriate arboviral disease testing during mosquito season.

In July 2016, CDC issued Interim Guidance for Health Care Providers Caring for Pregnant Women with Possible Zika Virus Exposure – United States, July 2016 (https://www.cdc.gov/mmwr/volumes/65/wr/mm6529e1.htm) that includes Zika virus immunoglobulin M (IgM) testing of pregnant women. However, some flavivirus infections can result in prolonged IgM responses (>12 weeks) that make it difficult to determine the timing of infection, especially in testing of asymptomatic people. Emerging epidemiologic and laboratory data indicate that Zika virus IgM can persist beyond 12 weeks in a subset of infected people. Therefore, detection of IgM may not always indicate a recent infection. Although IgM persistence could affect IgM test interpretation for all infected people, it would have the greatest effect on clinical management of pregnant women with a history of living in or traveling to areas with Zika virus transmission. Pregnant women who test positive for IgM antibody may have been infected with Zika virus and developed an IgM response before conception.

Tickborne diseases occur annually in West Virginia with most cases developing symptoms between April and September. Lyme disease is the most commonly reported tickborne disease in West Virginia. In 2016, West Virginia recorded 368 Lyme disease cases, the most ever in a single year. Counties in the northwestern and southwestern parts of the state have had increasing case counts in recent years. In 2016, 43 counties reported at least one confirmed or probable Lyme disease case. Based on new national reporting standards, West Virginia is considered a high incidence Lyme disease state.

This Health Advisory describes the identification of emerging Shigella strains with elevated minimum inhibitory concentration values for ciprofloxacin and outlines new recommendations for clinical diagnosis, management, and reporting, as well as new recommendations for laboratories and public health officials. Current interpretive criteria provided by the Clinical and Laboratory Standards Institute (CLSI) categorize these strains as susceptible to ciprofloxacin, which is a fluoroquinolone antibiotic and a key agent in the management of Shigella infections.

The epidemic of non-prescription opioid addiction has led to an increase in injection drug use, hepatitis C virus (HCV) infections, and hepatitis B virus (HBV) infections in West Virginia. Though West Virginia is a low incidence state for human immunodeficiency virus (HIV) infections, several counties have been deemed at high-risk for an HIV outbreak similar to the one in Scott County, Indiana in 2015 predominantly among people who inject drugs (PWID). In order to detect an outbreak of HIV among PWID, increased screening is necessary.